Provider Demographics
NPI:1023600582
Name:NORTON, SHAYNA KEARN (LMFT, CADC)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:KEARN
Last Name:NORTON
Suffix:
Gender:F
Credentials:LMFT, CADC
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:KEARN
Other - Last Name:COFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 N 200 E
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-5959
Mailing Address - Country:US
Mailing Address - Phone:208-716-1549
Mailing Address - Fax:
Practice Address - Street 1:288 N SHILLING AVE
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2332
Practice Address - Country:US
Practice Address - Phone:208-785-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11816101YA0400X
IDLMFT-7650101YP2500X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLMFT-304Medicaid